TRANSFER AND AMBULATION

Objectives:

After 1 hour of teaching-learning activities, the level 3 students will be able to:

1. define the following:1.1 ambulation1.2 rescue1.3 transfer

2. identify the factors that affect transfer and ambulation.

3. cite the pointers to observe during transfer and ambulation.

4. enumerate the methods of transfer and ambulation.

4.1 one-man carry4.1.1 assist to walk 4.1.6 arm drag4.1.2 carry in arms 4.1.7 cloth drag4.1.3 piggyback carry 4.1.8 feet drag4.1.4 fireman’s carry 4.1.9 inclined drag4.1.5 blanket drag 4.1.10 pack-strap carry

4.2 two- man carry4.2.1 assist to walk4.2.2 four-handed seat4.2.3 hands as a litter4.2.4 carry by extremities4.2.5 firemen’s carry with assistance

4.3 three-man carry4.3.1 bearers along side4.3.2 hammock carry

4.4 four/ six/ eight – man carry4.5 blanket carry4.6 improvised stretcher4.7 commercial stretchers4.8 ambulance or rescue van

5. specify the commands during transfer and ambulation.

6. cite the reminders during transfer and ambulation.

1. Definition of Terms

Ambulation – ability to walk from place to place.

Rescue - to save somebody or something from a dangerous or harmful situation.

Transfer – to move a person from one place to another.

2. Factors that Affect Transfer and Ambulation:

Age - greatly affects activity, during the infants and toddler period, mobility develops rapidly and is refined and expanded throughout childhood and adolescence and into young adulthood with effects to maximize the attributes.

Lifestyle - people learn early in life often from the families, the value of activity in relation to health.

Neuromuscular and skeletal impediments - disease and injuries that affect the neuromuscular or skeletal systems can hinder movement.

Nutrition - adequate nutrition supplies vitamins and minerals essential for bone function.

General Health - the client’s general health status is reflected on how the individual moves. Illness, disability, inactivity and chronic fatigue have unfavorable effects on musculoskeletal function.

Emotions - the client’s emotional state may influence posture and ways of moving about.

Attitudes and Values - people who are conscious with body mechanics and gait would protect their body structures and posture from injury.

Level of Understanding - understanding the elements of body mechanics would encourage its use.

3. Pointers to Observe during Transfer and Ambulation

Position your feet properly, they should be on a firm, level surface and positioned

shoulder-width apart.

When lifting, use legs; not your back to do the lifting.

When lifting, never twist or attempt to make any moves other than the lift.

When lifting with one hand, do not compensate. Avoid leaning to either sides. Keep

your back straight and locked.

Keep your weight as close to your body as possible.

When reaching:

keep your back in a locked-in position.

avoid twisting while reaching.

avoid reaching more than 15-20 inches in front of your body.

avoid prolonged reaching when strenuous effort is required.

When pushing or pulling:

push rather than pull whenever possible.

keep your body locked-in.

keep the line of pull through the center of your body by bending your knees.

if the weight is below the waist level, push or pull from a kneeling position.

avoid pushing or pulling overhead.

keep your elbows bent with arms close to your sides.

4. Methods of Transfer and Ambulation

One - man carry

Assist to walk

The most elementary form of transport is the walking assist.

Procedure: Patient’s weight burden is assumed by the first aider. The patient’s arm is placed across the back or waist, depending on what is

most advantageous at the time. The key to effectiveness of this procedure is not to impose any added force or strains on the injured part but rather to give the injured person a sort of walking crutch. Do not pull or tug at the patient’s arm across your shoulders, since this may be a source of discomfort o patient.

Carry in Arms

The arms carry can be used to move a conscious or unconscious casualty. It is generally used with an unconscious casualty or a conscious casualty who cannot walk. The arms carry is very tiring and is only used for short distances.

Piggyback Carry

Assist the patient to stand. Place her arms over your shoulder so they cross your chest. Bend over and lift patient. While she holds on with her arms, crouch and grasp each thigh. Use a lifting motion to move her unto your back. Pass your forearms under her knees and grasps her wrists.

Fireman’s carry

Used to be a common way for firefighters to carry injured or unconscious people away from danger.

To perform the fireman's carry, the carrier would grasp the subject's wrist and put the subject's arm across one of his shoulders. Then, the carrier would reach between the subject's legs, passing his arm between the subject's legs and then grasping behind the subject's thigh. To avoid back injuries, it is important for the carrier to lift the subject using the strength of his or her legs. The carrier would have hold of the wrist of the subject and his other arm would be holding onto one of the legs of the subject. The subject would have one arm and one leg hanging freely behind the carrier's back.

Carrying someone in this manner has several advantages. The subject's torso is fairly level, which helps prevent further injuries. When the subject's weight is evenly distributed over both shoulders, it is easier to carry them for a longer distance (50 feet or more).

Blanket Drag

An alternate method to the drag carry where the rescuer can use a blanket to support and pull the casualty.

Arm DragGrasp the arms of the victim and drag him to a safe place.

Cloth DragUses the victims upper clothing for dragging 1. Before using clothing to drag the victim, make sure that the clothing is

sturdy enough and that the victim will not be chocked in the process 2. Kneel next to the victim at the head 3. Grasp the clothing at the collar under the victim's head 4. Drag the victim to safety

Feet Drag By using a cloth or bandage, tie both feet of the victim and make sure that the extra bandage is placed at the center of both feet, then drag the victim. Make sure that there are no bumps to prevent injury to the victim.

Inclined Dragused to move a victim down a stairway or incline

1. Turn the victim so that the victim is supine 2. Kneel at the victim's head 3. Support the victim's head and neck 4. Lift the victim's upper body into a sitting position 5. Reach under the victim's arms and grasp the victim's wrists 6. Stand using legs rather than back to move the victim while easing

the victim down a stairway or ramp to safety

Pack- Strap Carry

The pack-strap carry is generally used to carry a conscious or unconscious casualty for a moderate distance. The carry is not used if the casualty has a fractured arm.

Two- man Carry

Assist to walk

Both rescuers position the patient’s arms over their shoulders.Each rescuer grasps the patient’s wrist, with the other arm around the patient’s waist.

Two-hand seat carry

This is another way to carry a conscious casualty who can neither walk nor support the upper body. Make a hook with your fingers by folding them towards your palm and grab onto your partner's "hook". If you don't have any gloves, use a piece of cloth to protect your hand from the other person's nails. This is yet another good reason to wear gloves.

Four handed seat

This is also a good carry for a conscious casualty who can use hands and arms for support.

Carry by extremities

An injured person can be carried by his extremities as shown here. However, this carry should not be used to carry a person who has serious wounds or broken bones.

Fireman’s carry with assistance

Have someone help lift patient. The second rescuer helps to position patient.

Three – man carry (Note: No illustration and description)

Bearers along side (Note: No illustration and description)

Hammock carry (Note: No illustration)

The three-person hammock carry is very similar to the two-person carry, except that three people are involved: One positioned at the victim's calves, one at the hips, and the third person at the shoulders. The carriers kneel on their knee nearest the victim's feet. The person at the victim's head gives the command, and all three lift the victim to their knees simultaneously. The victim is then turned so that he faces the rescuers. The person at the head then gives the command and the three rescuers stand.

Four/ Six/ Eight man carry

Four-man Carry

The four-man carry is the carry normally used to transport a littercasualty when the terrain is generally smooth and level.

1. The bearers position themselves as described below prior to performing the carry. The leader of the litter squad (bearer one) positions himself at the litter handle nearest the casualty's right shoulder, normally at the back of the litter. This position allows h im to observe the casualty and to direct the three other members of the squad. In figure 3-28, bearer one is the leader of the litter squad.

2 . The other three-squad members position themselves at the remaininglitter handles.

3. All bearers face the direction of travel and kneel on one knee (the knee near the litter). On the preparatory command "Prepare to Lift," each bearer grasps his litter handle with the hand closest to the litter and places his other hand on his raised knee. On the command of execution "LIFT," all bearers rise together, lifting the litter and keeping it level.

4. Each bearer uses the hand on his knee to help support and balance himself as he rises. Leg muscles, no t back muscles, are used when lifting a litter. This helps to prevent back injury.

5. After the bearers are standing, they are in position for the four-man carry. The command to proceed is "Four-Man Carry, MOVE." This command is also used to change to the four-man carry from another carry without lowering the litter.

Six man Carry

Blanket Carry

A variety of materials, such as blankets, can be used as improvised stretchers. The blanket carry can be used to remove victims who cannot be removed by other means. Six rescuers are recommended for this carry to ensure the victim'sstability during the move. One rescuer must be designated the lead person to ensure teamwork when performing the lift.

Improvised Stretcher

If a commercially prepared stretcher is not available, you can improvise one by using a tabletop, door, two rigid poles and a blanket or clothing. Don't use non-rigid stretchers for casualties with suspected head or spinal injuries.

Blanket and poles stretcher

1. Place the blanket flat on the ground and place a pole one-third of the way from the end. Fold the one-third length of the blanket over the pole.

2. Place the second pole parallel to the first so that it is on the doubled part of the blanket, about 15 cm (6 in) from the doubled edge.

3. Fold the remaining blanket over the two poles. The casualty's weight on the blanket holds the folds in place.

Stretchers from found materials

Doors, short ladders, sheets of galvanized metal, etc can all be used to improvise stretchers. Keep an eye out for suitable materials.

Make sure the stretcher and casualty will clear passageways and that the stretcher is strong enough to hold the casualty.

Commercial Stretchers

A kind of bed with rollers used for transporting the victim from one room to another. Commonly found in hospitals and ambulance.

Ambulance or Rescue Van

A vehicle used by health care practitioners/ rescuers in transiting patients to a near hospital.

5. Commands during Transfer and Ambulation

COMMANDS:

“Ready to kneel.”

-to position the rescuers beside the victim

“Hands over the victim.”

- to position the hands over insertion point of the victim

“Ready to insert.”

- to get ready to insert hands below the victim to create a litter

“Ready on the knees.”

-to make sure the rescuers are ready to lift the patient from the ground

“Clip.”

- to lock the victim in the arms of the rescuers, to prevent any accidents

“Interlock.”

- (for hammock carry) to lock each other’s arms for a much durable and solid litter

“Ready to stand.”

- to ensure a simultaneous manner of lifting the victim as to prevent further more injuries

“Stand.”

- signals the rescuers to stand

“Ready to walk.”

- to get ready for walking

“Head/Foot center pace.”

- to direct rescuers which way to go, either towards the direction of the head or feet of the victim

“Abort.”

- abort any action done to prevent further injuries

(e.g. when lifting victim on the knee and one rescuer loses grip, the leader will command them to abort lifting)

6. Reminders during transfer and Ambulation Know your own physical abilities and limitations.

Do not overestimate yourself or the other rescuers.

Before lifting, know or find out the weight of the patient as well as the weight

limitations of the equipment being used.

Call for additional help whenever necessary.

Even thought your first impulse may be to jump in to help the patient, you must not

proceed until you know you can do so safely.

Always try to use an even number of rescuers to maintain balance. Two rescuer

teams should carry heavy loads for one minute or less.

More time can generate a high level of muscle fatigue, which can significantly

increase the potential for injury.

Whenever possible, transport patients and equipment on wheeled stretchers or other

rolling devices.

When you must carry, keep the weight as close to your body as possible.

Keep your back in a locked-in position.

Do not hyperextend your back, or lean from the waist.

Refrain from twisting, and never lift and twist simultaneously.